Pec11 chap 45 mci and ics

Prehospital: Emergency Care
Eleventh Edition
Chapter 45
Multiple-Casualty Incidents
and Incident Management
Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Learning Readiness
• EMS Education Standards, text p. 1322
• Chapter Objectives, text p. 1322.
• Key Terms, text p. 1322.
• Purpose of lecture presentation versus textbook reading
assignments.

Setting the Stage
• Overview of Lesson Topics
– Multiple-Casualty Incidents
– National Incident Management System
– Triage
– Disaster Management

Case Study Introduction
EMTs Tom Hurley and Joe Meyer are the first EMS unit to
arrive on the scene of a tour bus collision, in which the bus
hit a bridge abutment. A half-dozen patients with various
injuries have made their way out of the bus. “Help us,” one
man says. “There are people dying in the bus.”

Case Study (1 of 3)
• What steps do Joe and Tom need to carry out to
establish an organized response?
• How should the EMTs decide which patients should be
treated first?

Introduction
• The number of patients needed to declare a multiple-
casualty incident varies according to the resources
available.
• Incident management, triage, and disaster response
plans are needed to effectively respond to multiple-
casualty incidents.

Multiple-Casualty Incidents
• An MCI is any event that places excessive demands on
personnel and equipment, and typically involves three or
more patients.
• A variety of events can lead to multiple casualties.
• It’s better to call too many rescuers than too few.

National Incident Management System (1 of 8)
• NIMS provides for a consistent approach to managing
disasters.
• The incident command system (ICS) is part of NIMS.
• NIMS provides for flexibility and standardization.

• NIMS involves specialized training and preparedness.
• Relationships built during preparedness are key to
effective response.
• NIMS is the template, the gold standard, in incident
management systems and command.

Relationships Developed During the
Preparedness Phase of NIMS
Worked to the advantage of responders and agencies in the aftermath
of Hurricane Katrina in 2005 as shown in this disaster triage and
treatment sector.
(© AP Photo/Dennis Paquin)

• Incident Command System
– An incident command system provides a
standardized approach to on-scene management.
▪ Uses best management practices to ensure
– The safety of the emergency responders and
others
– The achievement of tactical objectives
– The efficient use of resources

The Incident Commander Directs the Response and
Coordinates Resources at a Multiple-Casualty
Incident

– Features of ICS
▪ Uses common terminology and simple English
▪ Employs common designations for all
organizational resources
▪ Incorporates manageable spans of control
▪ Identifies of incident facilities
▪ Used distinct titles

– Features of ICS
▪ Incident action plans that identify the objectives to
be accomplished
▪ Integrated communications approach
▪ Accountability at all levels

– Designated ICS Sections
▪ Command
▪ Finance/Administration
▪ Logistics
▪ Operations
▪ Planning

EMS Branch Organization for a Major
Incident

– Incident command is initially assumed by the most
experienced and senior person of the first-arriving
service.
– Incident command can then be transferred to the
most qualified person in an orderly manner.

– Responsibilities of EMS units may include:
▪ Triage unit
▪ Treatment unit
▪ Transport unit
▪ Staging unit
▪ Morgue unit.

Basic ICS Organization for a Small- to
Medium-Sized Incident

Triage (1 of 12)
• Triage is a system used to sort patients to determine the
order in which they receive medical care or
transportation.
– Triage determines which persons need immediate
emergency care to survive their injuries, which
patients will live with a delay in emergency medical
care, and which patients will die, regardless of the
emergency care provided.

Triage Sector at the Houston Astrodome Where up
to 16,000 Evacuees from Hurricane Katrina Stayed
(© Carlos Barria/Reuters/Corbis)

Triage (2 of 12)
• Primary and Secondary Triage
– Primary Triage
▪ This task is by the first EMS crew.
▪ It is typically conducted at the incident site.
▪ Patients are tagged with a color-coded system to
allow organization of their removal from the
incident site.
▪ Patients are moved to the triage unit, where
secondary triage is performed.

Triage (3 of 12)
• START Triage System
– This system uses universal colors to identify priority.
– It is used for patients older than 8 years of age and
who weigh more than 100 lb.
– Each patient is triaged in less than 30 seconds.
– Patients are assessed for respiratory status,
perfusion, and mental status.

Triage (4 of 12)
– Ability to Walk (Ambulatory or “Walking Wounded”)
▪ Any patients who are already up walking around
the scene and those who indicate that they can get
up and walk should be collected and moved to a
safe area.
▪ Any patient who can walk is tagged “green.”

Triage (5 of 12)
– Respirations
▪ Assess the nonwalking patients by looking,
listening, and feeling for respiratory effort.
– Perfusion
▪ Assess the capillary refill and radial pulse.
– Mental Status
▪ Ask the patient to squeeze your fingers.

The START System

Triage (6 of 12)
• JumpSTART Pediatric Triage System
– Accounts for pediatric differences in physiology
– Used on any patient who appears to be a child
▪ Assess the following:
– Respiratory status
– Perfusion status
– Mental status.

Triage (7 of 12)
• SALT Triage
– Global Sorting
▪ Obvious Life Threats
▪ Purposeful Movement
▪ Patients Capable of Walking
– Life-Saving Interventions
– Assessment of Individual Patients
– Treatment and/or Transport

Triage Summary

EMS Personnel Must Have a Universally
Understood Triage Identification Tag System, as
Shown in the Photo (1 of 3)

Triage (8 of 12)
• Treatment
– The treatment, staging, and transport unit leaders
make decisions about priority of transport.

Triage (9 of 12)
• Staging and Transport
– Staging Unit
▪ Unit leader monitors, inventories, and directs
available ambulances to the treatment unit at the
request of the transport unit leader.
– Transport Unit
▪ Ensures ambulance accessibly and that transport
occurs with the direction of the incident
commander.

Triage (10 of 12)
• Communications
– Expect a variety of MCI communication difficulties.
• Follow-Through
– When all patients have been transported, EMS
personnel may be needed to assist at hospitals.

Triage (11 of 12)
• Reducing Posttraumatic and Cumulative Stress
– Try not to become overwhelmed by the incident; care
for one patient at a time.
– Rest periods should be provided.
– Each worker must be fully aware of their assignment.
– Someone should circulate and look for signs of
exhaustion or stress.

Triage (12 of 12)
• Reducing Posttraumatic and Cumulative Stress
– Rescuers should be assigned tasks appropriate to
their skill levels.
– Food and drink should be provided.
– Rescuers should be encouraged to talk among
themselves.
– Rescuers should have the access to trained
counselors after the incident.

Click on the Triage Category
Most suitable for a 30-year-old patient with a leg amputated
below the knee, who is awake, able to follow commands,
has respirations of 24 per minute, and a weak, rapid radial
pulse.
A. Green
B. Yellow
C. Red
D. Black

Case Study (2 of 3)
Joe establishes initial incident command, and advises
dispatch that there are 30 to 40 patients. Tom begins triage
by asking anyone who is able to leave the bus on his own
to do so. Left with nine patients on the bus, the first patient
Tom comes to is a man in his 50s who is confused and
having difficulty breathing.

Case Study (3 of 3)
• What additional information does Tom need in order to
categorize this first patient?
• Once additional help arrives, what incident command
sections will be established?
• How will EMS be organized within the ICS?

Disaster Management (1 of 9)
• A disaster is a sudden catastrophic event that
overwhelms natural order and causes great loss of
property or life.
• There is a great disparity between casualties and
resources.
• Disasters may be natural or man-made.

• Requirements of Effective Disaster Assistance
– Preparation of the entire community
– Careful preplanning
– Ability to quickly implement a plan
– Effective communication among responders

• Requirements of Effective Disaster Assistance
– Application of triage skills
– Organize quickly and utilize all emergency personnel
– Adapt the plan to meet special conditions
– Contingency plan for shelter and transportation for the
community
– Do the greatest good for the greatest number of
people

• Warning and Evacuation
– An evacuation and warning message should
communicate the following:
▪ The nature of the disaster, its estimated time of
impact, and estimated severity
▪ Safe routes out of the area
▪ Destinations for those who evacuate.

• Disaster Communications Systems
– Backup system should be included.
– System details should be designed ahead of time.
– Appoint one person who communicates with those
outside the disaster area.
– This person should stay in contact with hospitals and
rescue units.
– Area-wide communications are vital.

• Disaster Communications Systems
– Provide a central registration area.
– Road conditions and alternative routes are constantly
monitored and updated.
– Monitor hospital status.
– Do not allow vehicles en route to hospitals to
communicate with hospitals except if an emergency
occurs en route.
– Include communications recording ability.

• The Psychological Impact of Disasters
– Survivors suffer many negative emotions and physical
effects.
– Reactions depend on age, physical health, and
emotional health.
• Helping Disaster Patients
– Families of patients need and deserve accurate
information.
– Reunite families as soon as possible.

– Group people with their families and neighbors.
– Encourage people to do necessary chores.
– Provide emotional structure and expectations for the
emotionally injured.
– Help patients confront the reality of the disaster.
– Don't give false assurances.

– Assure patients that accepting help is in no way a
sign of weakness.
– Target high-risk patients for intervention.

Case Study Conclusion (1 of 2)
The first-arriving fire personnel assume incident command
as Joe joins Tom in completing primary triage. An EMS
supervisor is designated the EMS branch supervisor as two
arriving paramedics assume triage and treatment unit
positions. Joe is then reassigned to the transport unit.

Case Study Conclusion (2 of 2)
There are seven immediate, 18 delayed, and ten minor
patients. The patients are transported to three local
hospitals.

Lesson Summary (1 of 2)
• Response to MCIs requires standardized preplanning
and training.
• NIMS was established to provide standardization of MCI
response.
• The ICS identifies the authority and responsibilities of
responders at an MCI.

Lesson Summary (2 of 2)
• Triage is a mechanism for sorting and prioritizing patients
according to their injuries.
• Triage systems rely on color-coded tags.
• MCIs and disasters have profound psychological effects
on survivors and responders.

Correct!
The patient is breathing <30 times per minute, has a radial
pulse, and is able to follow simple commands. Therefore,
they meet criteria for yellow, or delayed, status.
Click here to return to the program.

Incorrect (1 of 3)
The patient cannot be categorized as walking wounded.
Therefore, they do not meet criteria for green, or minor,
status.
Click here to return to quiz.

Incorrect (2 of 3)
The patient has a serious injury, but their respirations are
<30, they do have a radial pulse, and are able to follow
commands. Therefore, they do not meet criteria for red, or
immediate, status.

Incorrect (3 of 3)
The patient has an open airway and is breathing.
Therefore, they do not meet criteria for black, or deceased,
status.

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